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A society that doesn’t like to discuss sex does not like to discuss safe sex, also does not discuss contraception methods. This is more so because sex is mostly considered reserved for reproduction, and outside of reproduction, women are apparently not supposed to have sex. Actor and sexual health activist Leeza Mangaldas talks about how in urban India, the onus of getting the condom is put entirely on men who then also acquire the agency to use it or not (and no, the ‘pull-out’ method doesn’t work!).
For women, however, it’s time to take the reins in their own hands, and finally, decide whom do we want to have sex with, if we want a child, and whom do we want to have a child with. Beyond the aspect of choice, contraception also enables sexual health. Mumbai-based obstetrician and gynaecologist (OB-GYN) resident Dr Esha Chainani points out how women are more susceptible to sexually transmitted diseases (STDs), and so careful use of contraceptives is only an enabler towards better sexual health. Beyond being preventive, contraceptive methods like birth control pills have also been found to help with menstruation.
Beyond just knowing about the importance of contraceptives, what remains is confusion and a lot of doubts and questions. In order to start off by touching base with the basics, Homegrown requested Dr Esha Chainani, who is also the creator of a multilingual pregnancy-care app called Premaa, to give us a Contraceptives 101 lesson. Premaa, which is available on the Google app store, also contains an expansive list of FAQs regarding contraception. We were also able to pick out a few questions and answers from Premaa in our attempt to cover this subject as deeply as possible.
Please note: The following are Dr Chainani’s personal opinions and not medical treatment or advice. Contraceptives should only be taken after seeking proper medical advice from a recognised gynaecologist.
What is the best method of contraception?
The kind of contraception you take depends on your partner. If you’re involved with one person and frequently have sex with them, then the birth control pill, implant or even the patch is effective. However, if you do not have sex regularly or frequently, or if you’re changing partners, taking the pill isn’t the best option. It’s a big deal to take the same pill every day on time, and if it is taken incorrectly, there is a high chance of failure.
Are birth control pills really bad for me?
Many have a misconception of birth control pills being bad for you because they are hormonal, and it mostly comes from the older generation. They are not that bad. We use oral contraceptives for a lot of things apart from just contraception. We use them to regulate periods, PCOS, endometriosis. If it was so bad, we wouldn’t be using them. The latest pills we have are low dosage of oestrogen and progesterone, sometimes they don’t have the latter. They have a diuretic which has very few side effects. They help with PMS and reduce flow during periods, amongst other benefits. Your fertility comes back 100 per cent after you stop using them too. They can also reduce incidents of some gynaecological cancers. They do have some side effects like anxiety, maybe depression but unfortunately there is no better alternative available as of now. What we have isn’t so bad, and I would prescribe it and advocate for it.
What if I miss my birth control pill?
If you don’t take your birth control pills regularly, (1) your periods will get messed up and you will start bleeding and (2) you will not be protected from pregnancy. There is no point in being irregular with them. That is an unfortunate part of the birth control pills so compliance is always a big problem. If you take them perfectly, they are the best method of birth control. So if you miss one pill, take the next one as soon as possible, or take two the next day. If you miss two pills, then you have to abandon taking them that month and use another method of contraception like condoms for that duration.
I don’t have sex very often so then do I need contraception? I don’t have a stable partner and I also want my periods to happen ‘naturally’, should I still be on the pill?
Sometimes even with one sexual encounter, you can get pregnant. Women have conceived during their periods, during their honeymoon and even when they just lost their virginity. Abortion takes a big toll on you mentally and physically so it shouldn’t be taken lightly. You need to make sure that you don’t conceive or contract a disease. So it’s a no brainer here — you do need contraception. Many patients come to us for abortions and it gets very difficult because there are so many health complications, sometimes it requires admission and D&C. It’s also a long legal process with many documents that go to the GoI- it is very regulated. It affects your next pregnancy and affects you to emotionally as well. I think that as an unmarried woman, getting pregnant should be one of the biggest fears.
Should I really be worried about Sexually Transmitted Diseases (STDs), particularly if I am in India?
STDs are very prevalent, especially in India. Maybe something like Syphilis is not so prevalent anymore but I have treated patients with Syphilis and it’s not like it’s unheard of. There are still a lot of cases of HIV in India and they are still present across all societies, so it’s not a socio-economic strata matter. It’s everywhere. Hepatitis B, Herpes, and Chlamydia are very common. In India, we like to hide a lot of things and not talk about it, so women are at a higher risk of contracting these diseases because men sometimes don’t care about it, don’t look after themselves or just don’t know. For women, HPV is a big problem — in men, it may be asymptomatic, there may be no warts or anything. In women, it leads to an increased chance of cervical cancer. Definitely, something we should be very careful about.
Are women at a higher risk of contracting STDs?
Women have a higher chance of contracting an STD if the man tests positive for it, but men have a lower chance of contracting it if the woman tests positive for it. We’re at a higher risk of contracting STDs, so we should be careful, particularly, if we have multiple sexual partners. It’s always better to use a condom.
If I have a child and don’t want more at all or for a few years then what’s the best method?
If you have a child and want birth-spacing contraception or don’t want children any more, I would suggest Copper-T or Mirena. Mirena is an LNG-IUS. It is like a Copper-T but also secretes small amounts of hormones that locally affect the uterus to regulate your period, etc. They’re ideal because you just insert them and leave them for 5-7 years. I would recommend against permanent methods like tubectomy/vasectomy because you never know what can happen. We get a lot of women who come in for a reversal of the surgeries because of various reasons including change of mind, death of their child and divorce.
Is it possible to have a child in the future if I take up contraception now?
If you’re on any method of contraception, it is definitely possible to conceive a child. Whether it be the implant, pill or anything else, one’s fertility can still come back. Even if you’re taking DMP injections, your fertility can come back. Sometimes it takes longer than others.
Is birth control right for me?
If you are of childbearing age, you may consider using a form of birth control to prevent becoming pregnant.
The practice of preventing pregnancy is as old as human existence. For centuries, humans have attempted to avoid pregnancy at certain times of their lives to accommodate their careers, marital situations and preferences.
The ability to control whether and when you become pregnant can affect your ability to achieve your own goals and can contribute to your sense of well-being.
Have you heard that if you have intercourse during your menstrual period, you won’t get pregnant?
This isn’t true. If you have a long menstrual period and a short cycle, you can still be ovulating at the end of your menstrual period. Some women have a small amount of bleeding during ovulation and may mistake it for a menstrual period. This means that you can still get pregnant during your period.
I am thinking of trying the pill, but my mother says it is dangerous for younger women.
I’m afraid she has this the wrong way round. The risks of the pill aren’t all that big, but they’re much greater in older women.
In the age group 16 to 25, the danger of serious side-effects from the pill is very small — unless you are a smoker or have other risk factors, such as a history of thrombosis (clots) or a family history of relatives who had heart attacks or strokes at an early age.
You will be asked about these things when you first go to a doctor to obtain the pill.
She should also check your blood pressure — because a raised BP does increase the risk of complications from the pill.
Does the pill turn women off sex?
No, this is largely a fantasy. Many women become rather more keen on sex because they know the pill is giving them excellent protection against unwanted pregnancy.
A very small number of women do say that the pill reduces their libido.
What to do if a condom tears during intercourse?
Please take an emergency contraceptive pill within 72 hours of unprotected intercourse. Also, get a pregnancy test if the next menstrual period is late.
Are condoms effective against HIV and other Sexually Transmitted Infections (STIs)?
Yes. Condoms have been proven to provide protection against STIs. IN fact, condoms are the only contraceptive method that also provides STI protection. Condoms provide different levels of risk reduction for different STIs because infections are spread — some are spread by contact with bodily fluids while others are spread by skin to skin contact.
In general, research shows that condoms are most effective in preventing those STIs that are spread by bodily fluids, such as chlamydia, gonorrhoea, and HIV. Condoms also can reduce the risk of contracting diseases spread by skin-to-skin contact such as Herpes and Human Papillomavirus (HPV). However, condoms only can protect against these diseases if the sores are in areas covered by the condom.
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